Anaesthesia for mitral valvotomy.

rx-tHE object of this paper is to discuss the use of nitrous X oxide supplemented with pethidine in the operation of mitral valvotomy for the relief of mitral stenosis. Direct surgery of the stenosed mitral valve is no new conception. Indeed, as far back as the year 1902, Brunton put forward the plea for surgical disruption of the stenosed valve, but he met with such determined opposition that his idea was allowed to lapse into obscurity. It was H. S. Souttar of the London Hospital who, in 1925, performed the first mitral valvotomy on a girl of 15 years of age. Anaesthesia in this case was punctuated by a series of crises, the pulse rate rising at times to 150 per minute and the heart being grossly irregular on handling. Despite an immediate post-operative systolic blood pressure of 60 mm.Hg, the patient made an uneventful recovery. Pribram, in Germany, reported one successful case in 1928. It is to Bailey of Philadelphia that we owe the modern operation of mitral commissurotomy, that is the splitting of the stenosed valve at either commissure. Following the publication of his work in 1949 many surgeons have attempted the operation. Baker, Brock and Campbell (1950), Brock (1950), in London; Murray (1950), in Montreal and Smithy, Boone and Stallworth (1950) in Baltimore, have published several papers on this operation.